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D J A Scott - One of the best experts on this subject based on the ideXlab platform.
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Return to work following varicose vein surgery: influence of type of operation, employment and social status.
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 2006Co-Authors: A. P. Wright, D.c. Berridge, D J A ScottAbstract:Abstract Objectives To determine factors which influence the time taken to return to work in patients undergoing varicose vein surgery. Design Prospective collection of data from patients at outpatient interview. Setting The Department of Vascular and Endovascular Surgery at a teaching hospital in the UK. Participants Two hundred and fifteen consecutive employed or self-employed patients attending the outpatient clinic for review following varicose vein surgery. Methods Data was collected from patients in the outpatient clinic approximately 6 weeks following varicose vein surgery. Type of procedure, gender, occupation status, category of occupation, the incidence of complications and the time taken to return to work (RTW) was recorded. Statistics were performed using Kruskal–Wallis H , Mann–Whitney U and chi-squared analysis. Results Two hundred and fifteen patients were included, 77 (36%) men and 138 (64%) women. One hundred and ninety-two (89%) were employed and 23 (11%) self-employed. One hundred and fifty-three underwent primary saphenofemoral (SFJ) surgery, 10 bilateral procedures, 23 primary saphenopopliteal surgery (SPJ), 14 redo operations, five combined SFJ and SPJ, two mid thigh Perforator Ligation, six phlebectomies without groin or popliteal surgery and two bilateral surgery for recurrence. There was no relationship of gender or incidence of complications to RTW. There was a significant difference ( p p H -testing. Paired Mann–Whitney U -analysis showed that this difference was between occupation class I (median RTW 2 weeks, interquartile range 1–3 weeks) and IIIN (median 3.5 weeks, interquartile range 2–5 weeks), IIIM (median 5 weeks, interquartile range 2–5 weeks), IV (median 4 weeks, interquartile range 2–6 weeks) and V (median 4 weeks interquartile range 3–6 weeks), and between class II (median 3 weeks, interquartile range 2–4 weeks) and classes IIIM, IV and V. Conclusions Employed patients and those involved in intensive manual labour are less likely to return to work early. There is no effect of gender or incidence of complications. On the basis of this study we would recommend that patients could return to work within 3 weeks of varicose veins surgery.
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Return to Work Following Varicose Vein Surgery: Influence of Type of Operation, Employment and Social Status
European Journal of Vascular and Endovascular Surgery, 2006Co-Authors: A. P. Wright, D.c. Berridge, D J A ScottAbstract:Objectives: To determine factors which influence the time taken to return to work in patients undergoing varicose vein surgery. Design: Prospective collection of data from patients at outpatient interview. Setting: The Department of Vascular and Endovascular Surgery at a teaching hospital in the UK. Participants: Two hundred and fifteen consecutive employed or self-employed patients attending the outpatient clinic for review following varicose vein surgery. Methods: Data was collected from patients in the outpatient clinic approximately 6 weeks following varicose vein surgery. Type of procedure, gender, occupation status, category of occupation, the incidence of complications and the time taken to return to work (RTW) was recorded. Statistics were performed using Kruskal-Wallis H, Mann-Whitney U and chi-squared analysis. Results: Two hundred and fifteen patients were included, 77 (36%) men and 138 (64%) women. One hundred and ninety-two (89%) were employed and 23 (11%) self-employed. One hundred and fifty-three underwent primary saphenofemoral (SFJ) surgery, 10 bilateral procedures, 23 primary saphenopopliteal surgery (SPJ), 14 redo operations, five combined SFJ and SPJ, two mid thigh Perforator Ligation, six phlebectomies without groin or popliteal surgery and two bilateral surgery for recurrence. There was no relationship of gender or incidence of complications to RTW. There was a significant difference (p
Thomas F. O'donnell - One of the best experts on this subject based on the ideXlab platform.
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Is the nihilistic approach to surgical reduction of superficial and Perforator vein incompetence for venous ulcer justified
Journal of vascular surgery, 2002Co-Authors: Mark D. Iafrati, Thomas F. O'donnell, Gary J. Pare, James M. EstesAbstract:Abstract Objective: Twenty-five years ago, the senior author showed a 55% postoperative ulcer recurrence rate after open Perforator Ligation. Those data contributed to a nihilistic attitude toward incompetent perforating veins. Conversely, since the introduction of subfascial endoscopic Perforator surgery (SEPS), we have undertaken ablation of superficial and Perforator reflux as initial treatment in patients with ulcers (C6) or healed ulcers (C5). This report outlines our long-term results. Methods: Between December 1994 and November 1999, SEPS was performed on 51 limbs in 45 patients with C5/C6 disease. Sixteen limbs underwent SEPS alone, and 35 had additional surgery on the greater saphenous vein (GSV), the lesser saphenous vein, or the tributary varicies. Data were collected according to the reporting standards in venous disease. Preoperative duplex scan of deep, superficial, and perforating veins was performed. Data were analyzed with Kaplan-Meier method, Mantel-Cox log-rank test, or t test. Results: Of the 51 limbs that underwent SEPS, the GSV was stripped in 28. Twenty-nine were C6, and 22 were C5. Etiology was primary (Ep) in 25 limbs and secondary (Es) in 26 limbs. All limbs had duplex scan evidence of Perforator incompetence (Ap), and deep insufficiency (AD) was seen in 39 cases (76%). Reflux predominated (PR). The clinical follow-up period was 0 to 82 months (median, 38 months). Venous disability scores improved from 9.8 before surgery to 4.2 at last follow-up (P
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Subfascial Dissection and Perforating Vein Ablation
Atlas of Endoscopic Perforator Vein Surgery, 1998Co-Authors: Mark D. Iafrati, Thomas F. O'donnellAbstract:The indications for and benefits of subfascial Ligation of incompetent perforating veins are enumerated in other chapters in this text. While the classic Linton operation or the stocking seam incision to approach perforating veins provides excellent exposure it is plagued by unacceptably high wound complication rates.1–3 Modifications of the open approaches (Chapter 9) have decreased wound complication rates; however, complete visualization of the subfascial space is difficult with these limited incisions. In recent years endoscopic approaches to Perforator Ligation have been developed both in Europe and in the United States. These minimally invasive techniques provide exposure to the entire subfascial space allowing complete Perforator ablation, while minimizing trauma to the skin and underlying tissues. The operation is comprised of three conceptually simple steps; incision, subfascial dissection, and disruption of Perforators.
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Subfascial endoscopic Perforator Ligation: An analysis of early clinical outcomes and cost
Journal of vascular surgery, 1997Co-Authors: Mark D. Iafrati, Harold J. Welch, Thomas F. O'donnellAbstract:Abstract Purpose: Early results of subfascial endoscopic Perforator surgery (SEPS) were examined. Data on ulcer healing, complications, and costs are presented. Methods: Data were prospectively collected for all patients who underwent SEPS at our institution. A concurrent control group was not available because primary open Perforator Ligation is no longer performed at our hospital. Preoperative assessment included duplex scanning (valve closure times and Perforator mapping), plethysmography, and phlebography. Completeness of therapy was assessed with postoperative duplex mapping of perforating veins. Clinical status was monitored after surgery, and actual costs, including equipment, personnel, and facilities management, are reported. Results: Eighteen procedures were performed in 15 patients (mean age, 52 years; range, 42 to 65 years). Two patients underwent bilateral SEPS, and one patient underwent a second procedure on the same leg. Active ulceration (class 6) was present in 14 of 18 limbs (78%), recently healed ulcers (class 5) in two of 18 (11%), and lipodermatosclerosis with edema (class 4) in two. Deep venous insufficiency was present in 14 of 18 (78%). The number of perforating veins ligated per leg ranged from 0 to 12 (mean, 4.3). Follow-up ranged from 3 to 64 weeks (mean, 22 weeks). Complete ulcer healing occurred in eight of 14 limbs (57%) at a mean of 14 weeks. Reduction in ulcer size was noted in four of 14 (29%), and two limbs were not improved. There were no new ulcers. Residual perforating veins were noted in four of 18 limbs. None of the limbs with residual perforating veins had complete healing of ulceration. Operating room costs were higher than those associated with limited-incision open Perforator Ligation ($2570 vs $1883). Conclusion: These preliminary data suggest that when used as part of a treatment plan to correct deep and superficial venous insufficiency SEPS results in a high rate of wound healing, with no recurrent ulceration in this series. Increased operating room costs associated with longer operations and greater disposable expenses will likely be overcome by shortened length of stay and diminished wound complications. These findings emphasize the importance of ligating all incompetent perforating veins, as ulcer healing was never achieved when residual perforating veins were found at follow-up. (J Vasc Surg 1997;25:995-1001.)
Mark D. Iafrati - One of the best experts on this subject based on the ideXlab platform.
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Is the nihilistic approach to surgical reduction of superficial and Perforator vein incompetence for venous ulcer justified
Journal of vascular surgery, 2002Co-Authors: Mark D. Iafrati, Thomas F. O'donnell, Gary J. Pare, James M. EstesAbstract:Abstract Objective: Twenty-five years ago, the senior author showed a 55% postoperative ulcer recurrence rate after open Perforator Ligation. Those data contributed to a nihilistic attitude toward incompetent perforating veins. Conversely, since the introduction of subfascial endoscopic Perforator surgery (SEPS), we have undertaken ablation of superficial and Perforator reflux as initial treatment in patients with ulcers (C6) or healed ulcers (C5). This report outlines our long-term results. Methods: Between December 1994 and November 1999, SEPS was performed on 51 limbs in 45 patients with C5/C6 disease. Sixteen limbs underwent SEPS alone, and 35 had additional surgery on the greater saphenous vein (GSV), the lesser saphenous vein, or the tributary varicies. Data were collected according to the reporting standards in venous disease. Preoperative duplex scan of deep, superficial, and perforating veins was performed. Data were analyzed with Kaplan-Meier method, Mantel-Cox log-rank test, or t test. Results: Of the 51 limbs that underwent SEPS, the GSV was stripped in 28. Twenty-nine were C6, and 22 were C5. Etiology was primary (Ep) in 25 limbs and secondary (Es) in 26 limbs. All limbs had duplex scan evidence of Perforator incompetence (Ap), and deep insufficiency (AD) was seen in 39 cases (76%). Reflux predominated (PR). The clinical follow-up period was 0 to 82 months (median, 38 months). Venous disability scores improved from 9.8 before surgery to 4.2 at last follow-up (P
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Subfascial Dissection and Perforating Vein Ablation
Atlas of Endoscopic Perforator Vein Surgery, 1998Co-Authors: Mark D. Iafrati, Thomas F. O'donnellAbstract:The indications for and benefits of subfascial Ligation of incompetent perforating veins are enumerated in other chapters in this text. While the classic Linton operation or the stocking seam incision to approach perforating veins provides excellent exposure it is plagued by unacceptably high wound complication rates.1–3 Modifications of the open approaches (Chapter 9) have decreased wound complication rates; however, complete visualization of the subfascial space is difficult with these limited incisions. In recent years endoscopic approaches to Perforator Ligation have been developed both in Europe and in the United States. These minimally invasive techniques provide exposure to the entire subfascial space allowing complete Perforator ablation, while minimizing trauma to the skin and underlying tissues. The operation is comprised of three conceptually simple steps; incision, subfascial dissection, and disruption of Perforators.
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Subfascial endoscopic Perforator Ligation: An analysis of early clinical outcomes and cost
Journal of vascular surgery, 1997Co-Authors: Mark D. Iafrati, Harold J. Welch, Thomas F. O'donnellAbstract:Abstract Purpose: Early results of subfascial endoscopic Perforator surgery (SEPS) were examined. Data on ulcer healing, complications, and costs are presented. Methods: Data were prospectively collected for all patients who underwent SEPS at our institution. A concurrent control group was not available because primary open Perforator Ligation is no longer performed at our hospital. Preoperative assessment included duplex scanning (valve closure times and Perforator mapping), plethysmography, and phlebography. Completeness of therapy was assessed with postoperative duplex mapping of perforating veins. Clinical status was monitored after surgery, and actual costs, including equipment, personnel, and facilities management, are reported. Results: Eighteen procedures were performed in 15 patients (mean age, 52 years; range, 42 to 65 years). Two patients underwent bilateral SEPS, and one patient underwent a second procedure on the same leg. Active ulceration (class 6) was present in 14 of 18 limbs (78%), recently healed ulcers (class 5) in two of 18 (11%), and lipodermatosclerosis with edema (class 4) in two. Deep venous insufficiency was present in 14 of 18 (78%). The number of perforating veins ligated per leg ranged from 0 to 12 (mean, 4.3). Follow-up ranged from 3 to 64 weeks (mean, 22 weeks). Complete ulcer healing occurred in eight of 14 limbs (57%) at a mean of 14 weeks. Reduction in ulcer size was noted in four of 14 (29%), and two limbs were not improved. There were no new ulcers. Residual perforating veins were noted in four of 18 limbs. None of the limbs with residual perforating veins had complete healing of ulceration. Operating room costs were higher than those associated with limited-incision open Perforator Ligation ($2570 vs $1883). Conclusion: These preliminary data suggest that when used as part of a treatment plan to correct deep and superficial venous insufficiency SEPS results in a high rate of wound healing, with no recurrent ulceration in this series. Increased operating room costs associated with longer operations and greater disposable expenses will likely be overcome by shortened length of stay and diminished wound complications. These findings emphasize the importance of ligating all incompetent perforating veins, as ulcer healing was never achieved when residual perforating veins were found at follow-up. (J Vasc Surg 1997;25:995-1001.)
A. P. Wright - One of the best experts on this subject based on the ideXlab platform.
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Return to work following varicose vein surgery: influence of type of operation, employment and social status.
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 2006Co-Authors: A. P. Wright, D.c. Berridge, D J A ScottAbstract:Abstract Objectives To determine factors which influence the time taken to return to work in patients undergoing varicose vein surgery. Design Prospective collection of data from patients at outpatient interview. Setting The Department of Vascular and Endovascular Surgery at a teaching hospital in the UK. Participants Two hundred and fifteen consecutive employed or self-employed patients attending the outpatient clinic for review following varicose vein surgery. Methods Data was collected from patients in the outpatient clinic approximately 6 weeks following varicose vein surgery. Type of procedure, gender, occupation status, category of occupation, the incidence of complications and the time taken to return to work (RTW) was recorded. Statistics were performed using Kruskal–Wallis H , Mann–Whitney U and chi-squared analysis. Results Two hundred and fifteen patients were included, 77 (36%) men and 138 (64%) women. One hundred and ninety-two (89%) were employed and 23 (11%) self-employed. One hundred and fifty-three underwent primary saphenofemoral (SFJ) surgery, 10 bilateral procedures, 23 primary saphenopopliteal surgery (SPJ), 14 redo operations, five combined SFJ and SPJ, two mid thigh Perforator Ligation, six phlebectomies without groin or popliteal surgery and two bilateral surgery for recurrence. There was no relationship of gender or incidence of complications to RTW. There was a significant difference ( p p H -testing. Paired Mann–Whitney U -analysis showed that this difference was between occupation class I (median RTW 2 weeks, interquartile range 1–3 weeks) and IIIN (median 3.5 weeks, interquartile range 2–5 weeks), IIIM (median 5 weeks, interquartile range 2–5 weeks), IV (median 4 weeks, interquartile range 2–6 weeks) and V (median 4 weeks interquartile range 3–6 weeks), and between class II (median 3 weeks, interquartile range 2–4 weeks) and classes IIIM, IV and V. Conclusions Employed patients and those involved in intensive manual labour are less likely to return to work early. There is no effect of gender or incidence of complications. On the basis of this study we would recommend that patients could return to work within 3 weeks of varicose veins surgery.
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Return to Work Following Varicose Vein Surgery: Influence of Type of Operation, Employment and Social Status
European Journal of Vascular and Endovascular Surgery, 2006Co-Authors: A. P. Wright, D.c. Berridge, D J A ScottAbstract:Objectives: To determine factors which influence the time taken to return to work in patients undergoing varicose vein surgery. Design: Prospective collection of data from patients at outpatient interview. Setting: The Department of Vascular and Endovascular Surgery at a teaching hospital in the UK. Participants: Two hundred and fifteen consecutive employed or self-employed patients attending the outpatient clinic for review following varicose vein surgery. Methods: Data was collected from patients in the outpatient clinic approximately 6 weeks following varicose vein surgery. Type of procedure, gender, occupation status, category of occupation, the incidence of complications and the time taken to return to work (RTW) was recorded. Statistics were performed using Kruskal-Wallis H, Mann-Whitney U and chi-squared analysis. Results: Two hundred and fifteen patients were included, 77 (36%) men and 138 (64%) women. One hundred and ninety-two (89%) were employed and 23 (11%) self-employed. One hundred and fifty-three underwent primary saphenofemoral (SFJ) surgery, 10 bilateral procedures, 23 primary saphenopopliteal surgery (SPJ), 14 redo operations, five combined SFJ and SPJ, two mid thigh Perforator Ligation, six phlebectomies without groin or popliteal surgery and two bilateral surgery for recurrence. There was no relationship of gender or incidence of complications to RTW. There was a significant difference (p
David Bergqvist - One of the best experts on this subject based on the ideXlab platform.
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Changes in superficial and perforating vein reflux after varicose vein surgery.
Journal of vascular surgery, 2005Co-Authors: Lena Blomgren, Gunnar Johansson, Agneta Dahlberg-Åkerman, Peter Thermaenius, David BergqvistAbstract:Objectives This prospective duplex study was conducted to study the effect of current surgical treatment for primary varicose veins on the development of venous insufficiency ≤2 years after varicose vein surgery. Methods The patients were part of a randomized controlled study where surgery for primary varicose veins was planned from a clinical examination alone or with the addition of preoperative duplex scanning. Postoperative duplex scanning was done at 2 months and 2 years. Results Operations were done on 293 patients (343 legs), 74% of whom were women. The mean age was 47 years. In 126 legs, duplex scanning was done preoperatively, at 2 months and 2 years, and at 2 months and 2 years in 251 legs. Preoperative perforating vein incompetence (PVI) was present in 64 of 126 legs. Perforator Ligation was not done on 42 of these; at 2 months, 23 of these legs (55%) had no PVI, and at 2 years, 25 legs (60%) had no PVI. Sixty-one legs had no PVI preoperatively, 5 (8%) had PVI at 2 months, and 11 (18%) had PVI at 2 years. In the group of 251 legs, reversal of PVI between 2 months and 2 years was found in 28 (41%) of 68 and was more common than new PVI, which occurred in 41 (22%) of 183 ( P = .003). After 2 years, the number of legs without venous incompetence in which Perforator surgery was not performed was 11 (26%) of 42 legs with preoperative PVI and 18 (30%) of 61 legs without preoperative PVI, ( P = .713). After 2 years, new vessel formation was more common in the surgically obliterated saphenopopliteal junction (SPJ), 4 (40%) of 10, than in the saphenofemoral junction (SFJ), 17 (11%) of 151( P = .027), and new incompetence in a previously normal junction was more common in the SFJ, 11 (18%) of 63, than in the SPJ, 3 (1%) of 226 ( P Conclusions Varicose vein surgery induces changes in the remaining venous segments of the legs that continue for several months. In most patients, Perforators and the GSV below the knee can be ignored at the primary surgery. A substantial number of recurrences in the SFJ and SPJ are unavoidable with present surgical knowledge because they stem from new vessel formation and progression of disease.